HomeMy WebLinkAbout1131 Declaratian af Dom:cile and ~iti~~nshi,~
"1'U Tlil: STAT~ AND ('OUNTY '1'AX ASSt:SSOR,
ST. LUCIE ~+~:~18
_ C'OUNTY, FLORIUA:
T!?is is my dcclaratiun of Domicilc and Citizcn~hip in thc Statc of Florida that l am Cling this day in
~ccordancc, and in confonnity with 5cction 222.17, Florida Statutcs.
I~~~as forn~crly a Icgal msidcnt of ~ and 1 •
(ci~r) (suce)
resided at • However, 1 have changed my domicite to
(Street and umber) ~
and am and have been a bona fide resident of the State of Florida since ~ day of
, 1911y and 1 reside at ~rLj-~~ ~ •
-i~~ ' (Street and Numbet)
~~L . St . Lucie County, Fiorida,
(c~~r)
:~nd this statement is to be taken as my dcclaration of citizenship, actual legal residence and domicile in the State
of Florida. .
(lnsert here any ~rlinrnt facts, such as s~lr uf propertY or busincss, w telinquichment of emploYment at formn
domicilr, temoval of tamily to new dumicile, purchase uf hume, etc.)
• HOrfESTEAD EXEriPTIOti: ~
ENTERIPIG CHILDREN IN SCHOOL. ~
If entering children in school,
please list their names:
~
~
~L/.~,n.e. _ f
~ ~ ~
;s
.
i:
~
i~WCIE COtElMCT
ROCER P~ITRAS ( ~
CIERK C1~CUIT COUItT
' R~CORl~ vER~FtEO
E ~R ~9
~
I
~ 2'79918
~ _
E
1 FURTHER CERTIFY that 1~vill register at my local address ~vhen the rcgistration books reopcn, and . _
comply with all other req~airements of a legal residcnt of this State. .
~ I FURTHI:R CEKTIFY that 1 have no intcntion to rcturn to my formcr domicile, and 1 intend to remain in ;
~ ' ST. LUCIE ;
~ , County, ~
Florida, pcrman ntly. tc~~r)
~ _
~ rV~, _i;~ ~y - ~
~ `,~~~tt~~!~~l~ a : ~ ~ ~ ~ . .
~ ~J~ r?a -c' ~I~~ /V J1V~
, ~~:~v C~1 • 3'F.~ . -
- ,`,1-- _y~,~•• ,i~-' ' ' 4
_~i' ~ . •,~a . . ? ~ • ,J: ~ , • ~
" = y - T ~ ~ :a S IGi~1ATUI~ '
~ : : ~
g ~w tJ~t9 anc~_st[t;sc~2fid Ucfore rnr thiti day of
9 • • - , ;
_ 74 b~~ %l~~~l~ ~ .
~ Y A.D. 19--- • . -~"1~'fai iny d" ress °
~t~~:•t~~".` `
~ ROGE POITRAS, CLERY. CIRCUIT COURT , Florida '
+a4 --r~w+~~
=i
i
Y+:S 3
IIy lleput}~ Clerk ~
(To hr ex ulyd u~ dupl~: atc ~nd ~~n~ in:d fJcJ aiU~ Clrr/. t'ircuit Cuotl. and dupli:alt ~•~th Tai Asutcor)
~
~ 9t,~~,~ ~ ~6 Pa;;E
` 1~30
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